Knowledge, experience and practice for acute Charcot neuroarthropathy amongst health practitioners: a mixed methods study
Deb Schoen1, Kashvi Dutta, Yi Shien Lew, Andrea Obek, Joanna Scheepers 1University Of Western Australia, Nedlands, WA, Australia
Abstract
Introduction:
Failure of early identification of acute Charcot neuroarthropathy (CN) compromises quality of life, potentially leading to foot complications and amputation. Delayed diagnosis results from poor foundational understanding, its management and a lack of structured referral pathways.
Aims:
To identify the baseline knowledge and experience of health practitioners regarding the identification and referral of acute CN and to improve awareness of an established referral process.
Methods:
A mixed open-ended and multiple-choice online Qualtrics questionnaire was distributed to approximately 377 participants from primary care and emergency and general medicine departments to test their approach to an unidentified case of acute CN. Participants viewed a pre-recorded education session regarding acute CN. The same questionnaire was re-sent a week later to identify improvements in knowledge. Data was coded with NVivo and analysed with IBM SPSS Statistics.
Results:
Four of the nine participants were unable to associate an erythematous, warm, oedematous, and neuropathic foot with a diagnosis of acute CN. Not all participants chose X-ray as their imaging modality and only one-third included offloading in their management plan, stating osseous destruction as the indication. Some referred to podiatry only when a foot ulcer or diabetes was present. Two participants completed the education session, demonstrating awareness and appropriate management improvements.
Discussion:
Improvements in understanding acute CN recognition, imaging work-up, appropriate offloading management and referral are required. An education tool should be implemented to address these aspects to increase health practitioners’ clinical suspicion of acute CN and subsequent immediate implementation of evidence-based management.
Keywords: Acute Charcot foot, Charcot neuroarthropathy, health practitioner knowledge
Biography
Deb is a passionate lecturer and podiatrist with specialist knowledge in Rural Health and High Risk Foot. Dr Schoen has worked in rural podiatry care in the Wheatbelt for 20 years, in High Risk Foot at Royal Perth Hospital and in private practice. She won the 2021 Rural Health West Excellence Awards for the Metropolitan-based Bush Champion. Dr Schoen combined her passions of Rural Health and High Risk Foot for her PhD to make a difference for Western Australian communities and the healthcare professionals dedicated to rural health